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The information you collect and record here is typically what both the police collision report centres and your insurance company will require.

A summary of this information will be e-mailed to the address you specify so that you can keep it for your records. The bodyshop will also receive a copy of this e-mail.

An asterisk (*) denotes a required field.

General Information:

* Date Of Collision

* Time Of Collision

* My E-Mail Address:

Location of Collision:

Officer Name:

Badge #:

Incident #:

Tow Truck Information:

Tow Truck Company:

Tow Truck Number:

Other Driver and Vehicle Information:

Other Driver Name:

Other Driver's License Number:

Address:

* Primary Phone #:

Type:

Secondary Phone #:

Type:

VIN:

License Plate:

Make, Model & Colour:

Insurance Company:

Policy #:

Expiry Date:

# Of Persons in other Vehicle:

Witness #1 Information:

Name:

Address:

Phone Number:

Witness #2 Information:

Name:

Address:

Phone Number:

Other Notes & Information:

Please enter any additional notes or information regarding your collision. You have 2000 characters.

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Accident Assistance

CALL NOW FOR
ACCIDENT ASSISTANCE

Contact Us

905-264-7022

collision@yourfinedealer.com

www.ccsdealers.ca

441 Hanlan Rd.
Woodbridge ON L4L 3T1

Record Your Accident Info

General Information:

Tow Truck Information:

Other Driver and Vehicle Information:

Witness #1 Information:

Witness #2 Information:

Other Notes & Information:

Accident Tips

Schedule An Appointment

Accident Assistance

CALL NOW FORACCIDENT ASSISTANCE

Contact Us

905-264-7022

collision@yourfinedealer.com

www.ccsdealers.ca

441 Hanlan Rd.Woodbridge ON L4L 3T1

Record Your Accident Info

General Information:

Tow Truck Information:

Other Driver and Vehicle Information:

Witness #1 Information:

Witness #2 Information:

Other Notes & Information:

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Accident Tips

CALL NOW FOR
ACCIDENT ASSISTANCE

441 Hanlan Rd.
Woodbridge ON L4L 3T1